title: Digital image analysis of mean AgNOR area objectively discriminates between reactive plasmacytosis and multiple myeloma in cytologic smears from bone marrow aspirates.
abstract: OBJECTIVE
  To differentiate between reactive plasmacytosis (RP) and multiple myeloma (MM) in bone marrow aspirates by assessment of silver-stainable nucleolar organizer regions (AgNORs).
  
  
  METHODS
  Archival cytologic smears (n = 69) from bone marrow aspirates were retrospectively investigated. Twenty cases had RP and 49 cases MM (24 low-grade, 22 intermediate-grade and 3 high-grade MM). Diagnoses were confirmed by evaluation of the corresponding bone marrow trephine biopsies. Cytologic smears were subjected to AgNOR staining using a standardized silver-staining protocol and assessed by two independent clinical histopathologists using digital image analysis. AgNOR count and area were analyzed in 100 plasma cell nuclei per sample.
  
  
  RESULTS
  The mean AgNOR area was found to be significantly (p < 0.001) higher in low-grade MM (mean: 23.4 microm(2); range: 19.2-26.7 microm(2)) than in RP cases (mean: 6.2 microm(2); range: 3.8-8.4 microm(2)). In contrast, mean AgNOR count failed to disclose significant differences between low-grade MM (mean: 5.36; range: 1-7) and RP (mean: 3.68; range: 1-6).
  
  
  CONCLUSIONS
  Digital image analysis of the mean AgNOR area might be used as a diagnostically useful adjunct to aid objectively in the challenging differentiation between RP and MM in bone marrow aspirates.
authors.affiliation: Institute of Pathology, HELIOS Clinics Bad Saarow, Charité-University Medicine Teaching Hospital, Bad Saarow, Germany. sven.gunia@helios-kliniken.de
authors.forename: S
authors.initials: S
authors.lastname: Gunia
authors.forename: P A
authors.initials: PA
authors.lastname: Mai
authors.forename: S
authors.initials: S
authors.lastname: Koch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D034961:Antigens, Nuclear / Q000032:analysis; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology; D009697:Nucleolus Organizer Region / Q000737:chemistry / Q000648:ultrastructure*; D010950:Plasma Cells / Q000473:pathology*; D012189:Retrospective Studies; D016622:Silver Staining
chemical_list: D034961:Antigens, Nuclear; C051963:nucleolar organizer region associated proteins